TY - JOUR
T1 - Evaluation of bone healing process after intramedullary nailing for femoral shaft fracture by quantitative computed tomography-based finite element analysis
AU - Mimata, Hideyuki
AU - Matsuura, Yusuke
AU - Yano, Sei
AU - Ohtori, Seiji
AU - Todo, Mitsugu
N1 - Funding Information:
The authors are grateful to Enago, Crimson Interactive Pvt. Ltd. for the English editing of this paper.
Publisher Copyright:
© 2022 Elsevier Ltd
PY - 2022/12
Y1 - 2022/12
N2 - Background: There is no proven method for quantitative evaluation of bone healing progress or decision to remove the nail after intramedullary nailing for femoral shaft fractures. Finite element analysis has become commonly utilized in bone analysis, but it may also be used to evaluate callus. The goal of this study was to use quantitative CT-based finite element analysis to assess the bone healing process and predict bone strength with the nail removed. Methods: Quantitative CT-based finite element analysis was conducted on CT images from patients who had intramedullary nailing after a femoral shaft fracture at 6, 12, and 15 months postoperatively. The failure risk of the callus was evaluated with maximal load throughout the gait cycle. The tensile failure ratio was calculated using the volume ratio of the callus element with a tensile failure risk ≥100%. A virtual model with the nail removed was built for bone strength study, and the strength was calculated using the displacement-load curve. Findings: The tensile failure ratio reduced with time, reaching 11.6%, 2.6%, and 0.5% at 6, 12, and 15 months postoperatively, respectively, consistent with bone healing inferred from imaging results. At 15 months, the bone strength at nail removal grew to 212, 2670, and 3385 N, surpassing the healthy side's 2766 N. Interpretation: Quantitative CT-based finite element analysis enables mechanical assessment during the bone healing process and is expected to be applied to the selection of revision surgery. It is also applicable to the nail removal decision.
AB - Background: There is no proven method for quantitative evaluation of bone healing progress or decision to remove the nail after intramedullary nailing for femoral shaft fractures. Finite element analysis has become commonly utilized in bone analysis, but it may also be used to evaluate callus. The goal of this study was to use quantitative CT-based finite element analysis to assess the bone healing process and predict bone strength with the nail removed. Methods: Quantitative CT-based finite element analysis was conducted on CT images from patients who had intramedullary nailing after a femoral shaft fracture at 6, 12, and 15 months postoperatively. The failure risk of the callus was evaluated with maximal load throughout the gait cycle. The tensile failure ratio was calculated using the volume ratio of the callus element with a tensile failure risk ≥100%. A virtual model with the nail removed was built for bone strength study, and the strength was calculated using the displacement-load curve. Findings: The tensile failure ratio reduced with time, reaching 11.6%, 2.6%, and 0.5% at 6, 12, and 15 months postoperatively, respectively, consistent with bone healing inferred from imaging results. At 15 months, the bone strength at nail removal grew to 212, 2670, and 3385 N, surpassing the healthy side's 2766 N. Interpretation: Quantitative CT-based finite element analysis enables mechanical assessment during the bone healing process and is expected to be applied to the selection of revision surgery. It is also applicable to the nail removal decision.
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U2 - 10.1016/j.clinbiomech.2022.105790
DO - 10.1016/j.clinbiomech.2022.105790
M3 - Article
C2 - 36327546
AN - SCOPUS:85141880571
VL - 100
JO - Clinical Biomechanics
JF - Clinical Biomechanics
SN - 0268-0033
M1 - 105790
ER -